From Hypertension to Heart Failure

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Arterial hypertension, coronary heart disease and heart fail­ ure are the commonest cardiovascular conditions to present in clinical practice. Over the past few years it has become in­ creasingly clear that they are closely and causally interrelated and that their relationship can have a significant bearing on prognosis. Epidemiological studies have shown that arterial hypertension is one of the most important risk factors for de­ veloping heart failure. Only one in four patients with hyper­ tension is adequately managed, and in 50% of cases, the hypertension has not been recognised or treated. Patients with pre-existing hypertension who go on to suffer an acute myocardial infarction have usually not previously had typi­ cal angina symptoms, the infarct territory is larger, life threatening arrhythmias are commoner and hence in-hospi­ tal mortality and long-term prognosis are markedly worse. The presence of raised blood pressure in the post-infarct phase doubles the risk of manifest heart failure. The close relationship between hypertension, coronary heart disease and heart failure makes the choice of therapeu­ tic strategy particularly important. Agents and classes of agents that have prognostic value in all three conditions should be considered first, as synergy might result in addi­ tional benefits. In such patients, this sort of therapeutic deci­ sion-making might have further advantages. The use of these agents may prevent complications which are not yet clinically obvious (such as heart failure).